A 58-year-old man collapses at home 30 minutes after the onset of severe retrosternal chest pain. Paramedics find him pulseless, and the monitor shows ventricular fibrillation. He is successfully defibrillated and taken to hospital where STEMI is confirmed. What is the most common cause of death in patients who die before reaching hospital with acute myocardial infarction?
- A Cardiogenic shock from extensive myocardial necrosis
- B Acute mitral regurgitation from papillary muscle rupture
- C Primary ventricular fibrillation ✓
- D Myocardial free wall rupture with tamponade
Correct answer: C. Primary ventricular fibrillation
Explanation
Sudden cardiac death from primary ventricular fibrillation accounts for the majority of out-of-hospital deaths in acute MI, occurring most often within the first hour of symptom onset before reperfusion therapy can be delivered. Cardiogenic shock, free wall rupture, and papillary muscle rupture are later complications that occur days into the hospital course, so they cannot explain prehospital death.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.